Assessing and Working with Mental Health Behaviors

According to the National Institute of Mental Health, about one in four
adults suffers from a diagnosable mental disorder in any given
year.1 Among people 65 years and older, Alzheimer’s
disease is the most common form of dementia; in fact, one in ten
individuals over age 65 is affected by Alzheimer's
disease.2 Currently, 4.5 million Americans are affected,
doubling the number of individuals affected by the disease since
1980.2

With such an increase in numbers, long term care facilities are seeing
more and more residents with dementia-related illnesses, such as
Alzheimer’s disease and other mental illnesses. Mental illnesses
can cause residents to present with a myriad of behaviors, including
outbursts or confusion. As more and more of the population ages,
facilities will see an increased number of residents with behaviors that
are a result of a mental illness. The challenge will be to ensure
that appropriate care is being provided to residents, and individual
needs are being met.

Residents with mental illness may or may not exhibit behaviors that can
be challenging. When they do, however, it is important to remember
that the person is reacting to his or her environment and illness and is
not attacking staff or loved ones with his or her reactions. It is
vital to distinguish the behavior from the resident. The resident
is not the problem; the behavior is. Focusing on the behavior and
not the personality of the resident allows staff to explore various
interventions geared to decrease that behavior. Facilities can
address behaviors successfully in order to ensure a safe environment for
the resident exhibiting the behaviors, as well as for other residents
living in the facility. When behaviors are first noted, staff
should begin to monitor them. For example, some residents may react
to certain staff differently or exhibit the behavior in the morning, but
not in the evening. Monitoring the behavior can help determine the
cause of it.

Assessing the resident is an important step that should coincide with
behavior monitoring. Social workers are trained to assess
psychosocial aspects of an individual. If a facility has a social
worker, the social worker should be notified so that he or she may
provide an assessment. Family members can often offer vital insight
into an individual’s behavior. This is important because a person’s
life experiences can impact his or her behavior. For instance, a
resident who is awake at night and wandering or calling out, may have
previously worked nights and is used to sleeping during the day.
From this assessment and knowledge of previous life experiences, the
social worker can make a number of recommendations to address behaviors.

If the facility does not have a social worker, or the social worker
believes it could be helpful to do so, the facility can request a
psychiatric consult. A psychiatrist can be requested to come in to
assess the behaviors and determine if the behavior is a result of a
mental illness. Psychiatrists can prescribe medications to address
some of the symptoms that result from a mental illness. For
example, a resident who is exhibiting symptoms of depression can begin to
have difficulty getting out of bed or enjoying activities. Some
medications can help with these symptoms. It is important to
remember, however, that psychiatric medications can have unwanted side
effects and may not completely address the behavior.

Residents who are showing symptoms of mental illness, such as
depression, can benefit from counseling services. Residents can go
out to see a therapist or a therapist can come in to the facility to see
the resident on a regular basis. Therapists can assess the
emotional, social and cognitive aspects of the illness and assist the
resident in developing coping skills.

Furthermore, residents who continue to exhibit behaviors that are
difficult for staff to handle could also benefit from a behavior
specialist. Behavior specialists are trained to develop plans that
specifically address a behavior. The behavior specialist can assess
the behavior and develop an individualized plan for that specific
resident. The behavior specialist will train the staff in
implementing the plan consistently. Behavior plans can be changed
and adapted to how successful the plan is at reducing the target
behavior.

Often, staff can feel powerless when they see behaviors in residents
with mental illness. The staff member may not know how to react in
order to decrease the behavior. It is important to recognize that
another person’s reaction to the behavior is a key factor in escalating
or de-escalating the behavior itself. Therefore, staff training is
critical in addressing challenging behaviors. Those staff members
trained in responding appropriately to challenging behaviors will feel
more empowered and will be better able to address behaviors.

Resources are often available from the Community Service Board (CSB),
which provides mental health services to the community. Case
management, psychiatric, and counseling services are often available
through the CSB. In addition, CSB or other mental health
professionals can provide staff training.

In conclusion, more and more residents in long-term care facilities are
exhibiting symptoms of mental illness that result in challenging
behaviors. Facilities can address behaviors in a way that allows
all residents to be cared for properly. It is also important for
the staff, therapists/specialists and authorized family members, to meet
periodically to formulate and implement a treatment plan to address the
behaviors.

Following is a checklist on steps to take to address behaviors as
well as what types of questions to ask:

Has the facility monitored the behavior? Are there any specific
patterns? If so, has the facility made changes to address
this?

Has the Social Worker or responsible staff assessed the resident and
spoken to family members to determine possible causes of the
behavior?

Has a psychiatrist assessed the resident? Could the resident
benefit from medications? Are medications being administered and
is the resident being monitored for side effects?

Could the resident benefit from counseling services? Have they
been offered?

Has a behavior specialist been consulted and a plan developed?
Has the staff been trained in the behavior plan?

Has staff received training in responding to challenging
behaviors?

References:

National Institute of Mental Health. The Statistics. Accessed
online October 2008.

National Institute of Mental Health. The Numbers
Count: Mental Disorders in America. Accessed online October
2008.